University of Toronto, Toronto, Ontario, Canada.
Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.
PLoS Negl Trop Dis. 2021 Jul 12;15(7):e0009516. doi: 10.1371/journal.pntd.0009516. eCollection 2021 Jul.
Zika virus (ZIKV) has generated global interest in the last five years mostly due to its resurgence in the Americas between 2015 and 2016. It was previously thought to be a self-limiting infection causing febrile illness in less than one quarter of those infected. However, a rise in birth defects amongst children born to infected pregnant women, as well as increases in neurological manifestations in adults has been demonstrated. We systemically reviewed the literature to understand clinical manifestations and health outcomes in adults globally.
This review was registered prospectively with PROPSERO (CRD 42018096558). We systematically searched for studies in six databases from inception to the end of September 2020. There were no language restrictions. Critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools.
We identified 73 studies globally that reported clinical outcomes in ZIKV-infected adults, of which 55 studies were from the Americas. For further analysis, we considered studies that met 70% of critical appraisal criteria and described subjects with confirmed ZIKV. The most common symptoms included: exanthema (5,456/6,129; 89%), arthralgia (3,809/6,093; 63%), fever (3,787/6,124; 62%), conjunctivitis (2,738/3,283; 45%), myalgia (2,498/5,192; 48%), headache (2,165/4,722; 46%), and diarrhea (337/2,622; 13%). 36/14,335 (0.3%) of infected cases developed neurologic sequelae, of which 75% were Guillain-Barré Syndrome (GBS). Several subjects reported recovery from peak of neurological complications, though some endured chronic disability. Mortality was rare (0.1%) and hospitalization (11%) was often associated with co-morbidities or GBS.
The ZIKV literature in adults was predominantly from the Americas. The most common systemic symptoms were exanthema, fever, arthralgia, and conjunctivitis; GBS was the most prevalent neurological complication. Future ZIKV studies are warranted with standardization of testing and case definitions, consistent co-infection testing, reporting of laboratory abnormalities, separation of adult and pediatric outcomes, and assessing for causation between ZIKV and neurological sequelae.
寨卡病毒（ZIKV）在过去五年引起了全球关注，主要是由于其在 2015 年至 2016 年期间在美洲再次出现。此前，人们认为它是一种自限性感染，导致不到四分之一的感染者出现发热疾病。然而，已经证明，受感染孕妇所生的儿童出现了更多的出生缺陷，以及成年人的神经表现也有所增加。我们系统地审查了文献，以了解全球成年人的临床表现和健康结果。
本综述前瞻性地在 PROPSERO（CRD42018096558）上进行注册。我们系统地在六个数据库中搜索了从成立到 2020 年 9 月底的研究。没有语言限制。使用 Joanna Briggs 研究所的关键评估工具进行了关键评估。
我们在全球范围内确定了 73 项报告寨卡病毒感染成年人临床结果的研究，其中 55 项来自美洲。为了进一步分析，我们考虑了符合 70%关键评估标准并描述了确诊寨卡病毒感染的研究。最常见的症状包括：皮疹（5456/6129；89%）、关节痛（3809/6093；63%）、发热（3787/6124；62%）、结膜炎（2738/3283；45%）、肌痛（2498/5192；48%）、头痛（2165/4722；46%）和腹泻（337/2622；13%）。14335 例感染病例中有 36 例（0.3%）出现神经后遗症，其中 75%为格林-巴利综合征（GBS）。一些患者报告在神经并发症的高峰期后康复，但有些患者则持续存在慢性残疾。死亡率很低（0.1%），住院治疗（11%）常与合并症或 GBS 有关。
成人寨卡病毒文献主要来自美洲。最常见的全身症状是皮疹、发热、关节痛和结膜炎；GBS 是最常见的神经并发症。需要进一步开展寨卡病毒研究，标准化检测和病例定义，一致进行合并感染检测，报告实验室异常，区分成人和儿科结果，并评估寨卡病毒与神经后遗症之间的因果关系。
